Blog 4: Stay out of the Waiting Room

     This is my second holiday season as an ER nurse, and, same as last year, I am struck with thankfulness for the life and opportunities that I have been blessed with! I spend so much time stressing out over $$$ that I don't have, but then I see people coming in wearing 3-4 layers of clothes, carrying beat-out suitcases and trash bags full of stuff, and looking cold, miserable, hungry, and hopeless, and I know I can't complain!...

     This time of the year, the ER waiting room stays full most of the day, largely due to the cold and flu season picking up steam and the homeless population seeking "3 hots and a cot." A full ER waiting room is an intimidating place! The sheer amount of bacteria swimming around out there is scary enough, but everyone is angry and at the end of their limits. Opening the door between the main ER and the waiting room is a gamble each time! If I had to put a sound effect to the words "ER waiting room," it would be the sound of a fuse being lit! I've had to brave the waiting room quite a bit the last few weeks, as I've been assigned to the "mid-level and chairs." This assignment basically means that I am the nurse for the nurse practitioner that sits at triage and sees each patient as they are being triaged for the first time. The NP will put in orders for that patient such as labs, urinalysis, cultures, flu/strep swab, IV insert,  IV fluids, nausea meds, breathing treatments, ect... It is then my job to call each patient back to my little area of 4 reclining chairs and a lab station, get an IV and fluids started, send the blood work and the UA to the lab, and give the meds. When the patient is completed with whatever needs to be done, I send them back out into the waiting room until an actual room in the ER becomes available so the doc can see them. This whole assignment can get a little hairy when you have an entire waiting room of people. The scariest part for me is the fact that some of people waiting out there in the masses actually are very sick, and sometimes they literally try to die on me in the waiting room... THAT is the worst! I've had one guy who kept downing nitro for his "chest pain" and lowered his BP so far that he fell out on the waiting room floor and another lady that started having a stroke as she sat in the waiting room. It always makes me feel awful when we have to carry someone back to the trauma rooms and resuscitate them because they've spent too much time in the waiting room and became critical in those hours.On the flip side, there are so many people that don't necessarily even need to be there and can't seem to understand why they are waiting for hours on end. I used to try to explain to people that the doctors and nurses behind those double doors are NOT just sitting around and eating pizza and that the people that go back before them are actually a lot sicker, but anymore these days, I just nod and apologize and say "I'll see what I can do." I kind of enjoy it when something happens that puts their "emergencies" into perspective...For instance, early evening last week, I was sitting at my lab station with a patient when I heard some blood-curdling yells go up in the waiting room. I quickly got fresh gloves and went out there to see what was up, (along with most of the nurses in the ER, it really was loud and sounded serious!!!).... Some poor lady was running around yelling "MY BABY, MY BABY! SOMEONE HELP MY BABY! OH PLEASE LORD NOT MY BABY!" We soon found out that her teenage child had been shot in the head and was coming into ER via a bystander vehicle. She had beat the vehicle to the ER and raised the alarm along with half the dead of the city. At any rate, the waiting room was pretty docile for a while after that!

      And then, we have the ER frequent flyers who get discharged and don't want to leave... For real, last week one lady who was discharged into law enforcement custody threw herself onto the lobby floor with enough force to open up a nice forehead laceration and splatter the triage area with blood. It's times like that when I really have to silent pray for patience and bite down on my tongue... Still makes me mad just typing about it. 

     At least there is humor mixed in with the craziness! Just Tuesday, I walked out into the waiting room and saw one of our "cute" little frequent flyers sporting only one penciled eyebrow that was raised very indignantly in my direction and I literally snorted out loud! 

    I feel like the last few weeks have had some crazy moments, but so often, when I sit down to write this blog, I can't remember everything that I wanted to write about! Here are a few of the moments that stuck with me from the last few weeks:

• Thanksgiving Day seemed to be Code Blue day... I was in a code literally 10 minutes after clocking in. I was actually able to get an IV on both codes I was involved in that day. May not seem like much, but for me, it was something! Getting an IV during CPR is hard, especially because the blood sometimes is hardly moving in the veins... 
• Cute old redneck codger who got his thigh cut pretty badly with a saw of some sort... he had these jeans with the neatest colorful patches sewn on the knees. When I asked him about them, he said that he had sewn them on himself... bless his heart! You'd have to see these jeans to understand why they were memorable, but I feel like he was an artist at heart! 
• Poor suicidal lady whose family tried to bring her to the hospital only to have her bail out of the car on the way... I remember her because she was all dressed up in Western gear when they brought her in and I had to take off her fancy cowboy boots... Not sure why that stuck with me! It's weird what stays in your head sometimes! Poor lady, I think her son had died recently or something. 
• The brownie guy... Every holiday there is an old gentleman and his son who bake brownies for the entire ER staff. He brings a plate of brownies to each nurse's station and thanks each one of us personally. He came around and gave each of us a hug and a peck on the cheek on Thanksgiving Day... His wife died in our ER a couple years before I started working there, from what I understand, but I guess it made a big impression on him because he literally is there with brownies every major holiday... Just made my day! And the brownies were really good, too! I had 3! 

     Here's to each and every one of you that read my blog! I hope you have an amazing holiday season! I'll leave you this time with a tale of blood and gore!....

                            My First Time Witnessing a Resuscitative Thoracotomy
     This story will be short and sweet but bloody, so don't say you weren't warned!!! 
     A thoracotomy aka cardiac massage is a procedure done in some situations when a patient is not responding to CPR, shocks, meds and any other resuscitative things being done... basically it's a last ditch effort at saving your life. It's usually reserved for young patients, trauma patients, and people that most likely have otherwise healthy hearts... 
     This particular night, we got the call for a trauma alert headed our way... the patient was a young woman who had been hit by a car and was being coded on the way to the ER. When EMS arrived, they hadn't got ROSC (return of spontaneous circulation) so the ER staff kept trying for the better part of an hour... Finally the Dr decided to do a thoracotomy... Basically, this means he is going to literally make a hole in the chest wall and use his hands to directly massage the heart to try to get it beating again. As you can imagine, this type of procedure is a blood bath! It also involves some very large tools to cut the ribs and hold the hole open... This time, when the doctor first glimpsed the patient's heart, he saw massive trauma to the heart and called the code. To this day, I can see that poor girl lying there, dead, naked, with a hole in the side of her body, blood everywhere, but with her fake eyelashes and makeup literally still perfect!  
     We heard later that the patient had been pushing a stroller down the sidewalk when a speeding car hit them from the side, a hit and run... the EMS said the infant in the stroller died instantly from massive head trauma. They said there was brain matter where it shouldn't have been... The worst part was that the lady that was pushing the stroller wasn't the mother. The mother was also hit by the car but just barely grazed, so she had to see her baby lying there like that... I honestly don't know how you can recover from something like that!
     The community came out in full force for that tragedy! I remember leaving an hour late that night and the parking lot was so full of people standing around and wailing (literally!), that the police department had to do crowd control just so ambulances could get in the bay. I wanted to say something to some of those people, something comforting, but I didn't have a clue what to say, so I just walked to my car, got in, and drove away... just so thankful to God that it wasn't my family or someone that I knew! 

*Disclaimer: Any names, ages, or genders may have been changed for this blog. If anyone feels that any part of this post violates HIPAA, please comment below... I'm trying to be as vague as possible about ID but want to give as many details as possible!